Month / December 2010

Trouble is that patients still seem to think that nurses are not real people. I would be angry if nobody cared about my safety from an institutional standpoint, as was the case in my previous post, but that does not apply in my current position. The issue that steams me lately is the apparently novel idea that nurses are not waitresses, punching bags, ignorant children, maids, or housekeepers. I’m tired not only of being punched and kicked, but also of being ordered around (“go get me some water”) and even of, eg, being belched on. Would you burp on someone anywhere else and blow it in her face? No! So why is it OK when it’s a nurse? Where is it written that normal rules of adult engagement are off when one party is a nurse?

There must be a magical aura around hospitals where behavior that is unacceptable ANYWHERE else is suddenly acceptable. Nurses get the brunt of it. Sorry, getting hit, spit on, yelled at and generally treated like shit is nowhere in my job description. Really, I’ve looked and read my job description. Not there, sorry.

This last week beat the snot out of me. I really want to write a resounding “Fuck yeah!” and a post related to some great nursing writing by Not Nurse Ratched and Those Emergency Blues, but I don’t have it. I’m running on empty from a worse week than normal. If we weren’t getting screwed by the patients, the ED, docs and our fellow nurses there was a general feeling of being under a bad moon. I feel like I saw the future of my floor this week: it wasn’t pretty. I want to say more, but can’t formulate coherent logical thoughts. Believe me, I’ve been trying. Nothing seems to flow right. I have some snippets put down, but can’t seem to make them go anywhere.

Go read these posts. They’re beyond good and in many ways capture what I’m thinking better than I can.

I have this feeling of impending doom regarding my unit. What they write about is evolving on my unit and I am scared to death about it. I feel that even though my manager wants our input, doing so would make me (and every other charge nurse) complicit in the same destructive behavior described above. I don’t want any of it.

For some people, extended unemployment benefits helps put food on the table, even though local private charities are more than capable of handling the role as government bread winner. For millions more, extended unemployment benefits are a reason to celebrate by going on vacation on the backs of hard working tax payers.

Prolonging unemployment benefits prevents people from tightening their belts, tightening their expenses and searching for a job. It prevents the sense of urgency needed when looking for a job. I’ve heard it over and over again over the last several years. Many people can’t find a job. But many more people don’t care and have no desire to look because they’re getting free money. They paid into a safety net, not a free vacation fund. If they want eight weeks of paid vacation, they should move to Europe, which is crashing and burning under a mound of debt.

There will always be the assholes who will take advantage of the situation, but there are a lot of people who desperately want work, yet can’t find it. I know that the view from the Ivory Tower must make it seem like anyone on unemployment is a lazy slovenly good-for-nothing that needs to go get a job based on your one conversation with a miscreant who decided to abuse the system, but that view is fucked up. I’ve met a lot of people out of work, good honest people who want more than a job slinging hash at McD’s and the unemployment benefits are what keeps them and their families off the street. Private charities? Yeah, good luck with that. And “tightening the belt” do you know what the average monthly pay out is? It ain’t much. I’ve been there, it sucks. And the longer you’re out of work the more despondent one can become. It’s a vicious cycle.

So you had an encounter with one person who is abusing the system, big deal. There’s a lot out there who aren’t. Don’t judge based on one person, I don’t think all hospitalists are douches.

The year is winding down and once again I come to you with desperate tidings. In spite of continuing efforts to reduce costs, namely flexing those that care for our patients leaving less staff to do more work, we are still having financial difficulties. I applaud your ability to work short and do what is needed to maintain our valuable cadre of upper-level management. I wanted to let you know that us at the Head Orfice have been trying to do our part as well and flexing out early for 2-3 hour lunches and not using the expense accounts for our golf trips. I know that your hard work is making things on our multiple vice-presidents easier.

But times are tough. Our revenues are down, mostly due to a change in our payer mix and as the economy here in our section of the country is slow to respond they will probably stay that way. We have been looking at opportunities to grow our business lines, but unfortunately the only ones coming to our hospitals these days are folks who can’t and will probably never pay their bills. In order to cover some of these cost we are passing them on to our employees, who in addition to caring for these folks now get to foot the bill as well. I know a lot of you are upset that we raised premiums (again) this year and changed co-pays and reduced the amount of things we will pay for, but it is a rough world out there and at least you still have health insurance.

I have been sitting down with the Vice-Presidents and they will shortly begin having meetings with upper-level management who will then be meeting with middle-management, who then will meet with your unit managers to work on the operating budgets for the next fiscal year. Sacrifices will have to be made at one point. We’re hoping this doesn’t include layoffs, but instead we will flex and cancel people so that they have a de facto pay cut since they no longer work their scheduled hours. We’re all doing it. In fact I am taking off time this month as well, flexing. Of course, my salary isn’t remotely effected. We here at the Head Orfice do appreciate your sacrifices, but are asking for more. We need you to do more with less. Our new operating budgets will reflect that. There are going to be hard decisions to make in the next year and I hope that our staff will be willing and able to make the changes needed and if not I’m sure there are plenty that will.

On a high note, we passed our Joint Commission survey, but in light of the new programs the Joint Commission will be rolling out in the next couple of years we have decided to hire a new group of compliance experts instead of bedside staff. More paperwork is the answer to cure any Joint Commission issues, not staff. So these colleagues will be finding new and inventive way to build checklists, peer-reporting, new charting screens and more compliance workshops (it’s mandatorily voluntary) to keep us in line for the next audit. Please welcome these folks onto your units so they will be able to further criticize your practices, fulfill their duties and create a blizzard of paper.

In this light I would also like to welcome two new Vice-Presidents to our cadre. Jenny Smith, MBA, BS in BS, MDiv, PhD, MPH will be our new Vice-President of Monotonous Paperwork. All of the compliance checklist folks will be reporting to her. Also, please welcome Bob Smith, MD, MBA as our new Vice-President of Vice-Presidents. His job will primarily be the identification or creation of need for new Vice-Presidents and the recruitment of those folks. If you have questions about this, please wait until the New Year as all of the Senior Management will be on vacation thanks to the generous bonuses they received this year. I know you all have enjoyed the special holiday dinner and ornaments we provided in years past, and are sad we canceled them this year, but the bonus money had to come from somewhere.

Last, but not least, we are going to be building a new completely un-needed hospital in the near future and this will be the kick-off of a fund raising drive where you the employees will contribute to the building cost. This is voluntary of course, but your very own co-workers will be soliciting you for “donations” to this new facility. The preliminary plans look great as there will be a full Italian marble facade and flooring in the main areas of the hospital, a waterfall and a place for a piano player. The patients rooms though are of no import as of yet, but we’ll get back to you on that.

So before I finish to go on a month long trip to Hawaii, I want to wish each and every one of you a Happy Holidays! See you next year!

Yours,

I-Make-Too-Much, MD, CEO

***if you think I’m only joking, remember, the funniest things are funny because they are partly true***

“Can someone give me a hand in here?!” came the frantic cry. I looked up to see Dr. Flighty in full isolation regalia trying to keep a very naked guy from running into the hall. As I got closer I saw the wild look in hie eyes, the look of fear, of the flight-or-flight reflex on overdrive.

“Hey, Mr. Smith…calm down there.” I said interposing myself between him and the hall as three other colleagues ran to our aid.

“”I. Have to. Get out of here…” said Mr. Smith looking around bewildered at the ruckus and chaos around him.

He was wiry dude. Not tall, but strong – not in a bulging physique way, but the wiry lean cable-like strength of a life-long manual worker. And I was having a hard time controlling him. It was a battle between him running and him falling.

“Let go of me! Leave me be!” he said. I could see the animal fear in his eyes. “I’m not staying in that bed. I’m not staying in this room. I’m going home!”

“Look Bob,” I said, my tone calm, even, looking him in square in the face. “I know you’re freaked out. You’re scared, I can tell. You don’t know what the heck is going on. Am I right?”

He nodded his head so I continued, “You’re here because of the nosebleed, remember? They gave you some medicine to calm you down so they could fix the nosebleed and now it’s making you feel very strange.”

The fear subsided a bit, but it was still there, a lingering caged animal lurking just below the surface. “Now we’re just trying to keep you safe. I know you’re scared, that you don’t know where you are, or that no one knows you’re here. That’s my job, to keep you safe, OK? Your job right now is to stay in bed, OK?”

He was still straining in our grip, so I eased up. “Can you do that for me Bob?” I finished.

Bob started to shuffle back towards the bed. “This stuff will wear off, I promise you. But you’re too unsteady to be up moving around by yourself, that’s why I need you to stay in the bed.”

Slowly Bob got into his bed. We fixed his gown, re-hooked the telemetry leads, all the time reassuring him that this is what he needed to do. It wasn’t complete capitulation on his part though, it was grudging at best, his glowering eyes told me that. But he stayed in bed and slowly drifted off to sleep.

“He’s going to be a little embarrassed in the morning,” I said to no one in particular. “And we’re going to add Versed to his allergies!”

“What did he have done?” asked Dr. Flighty, clearly shaken from having been chased out of the room by a naked guy. “Had a raging nosebleed that wouldn’t stop, even around the balloons, so he went to cath lab for a coil embolization, think he had a little bit of reaction to the Versed or Fentanyl.” I replied with a smile.

Skip ahead to the next morning.

“Hey Wanderer, Mr. Smith wants to see you.” said another of my colleagues.

I walked into the room. He was sitting there in blue paper scrubs with a sheepish look on his face. He reached for my hand and said, “I’m so sorry if I caused any trouble last night.” he said, visibly shaken.

“You’re welcome,” I said, shaking his outstretched hand. “Not really trouble. You just kept on us on our toes for awhile.”

“I don’t remember much, but I do remember your voice. Thank you for helping me out.” he said.

“It happens from time to time. We’re kind of used to it. I don’t hold it against you at all, just glad you’re feeling better.” I replied and walked out of the room with a grin on my face.

If he only knew the extent of his behavior he would have been mortified as he seemed like one of those straight-laced types. But we’re professionals and left him to his own memories because I know deep inside he knows and it would only shame him if we brought it up. Best to leave it alone I figured. Best thing though? In the midst of all the commotion, neither his arterial site or nose bled!